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Hua Y, Youens KE, Castro E, Wang D, Hodjat P, Shan Y. Autopsy findings in a 6-month-old infant with rhabdoid tumor predisposition syndrome 1: Case report with literature review. J Neuropathol Exp Neurol 2023; 82:1040-1043. [PMID: 37952236 DOI: 10.1093/jnen/nlad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Affiliation(s)
- Yinan Hua
- Department of Pathology, Baylor Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Kenneth E Youens
- Department of Pathology, Baylor Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Eduardo Castro
- Department of Pathology, Baylor Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Dapeng Wang
- Department of Pathology, Baylor Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Parsa Hodjat
- Department of Pathology, Baylor Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Yuan Shan
- Department of Pathology, Baylor Scott & White Medical Center and Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
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2
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Allen J, Shaikh A, Laurent-Ariot K, Merola M. A Rare Case of Intravascular Large B-cell Lymphoma Presenting With Bilateral Ophthalmoplegia, Along With a Literature Review. Cureus 2022; 14:e25920. [PMID: 35844347 PMCID: PMC9280704 DOI: 10.7759/cureus.25920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/23/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a subtype of extranodal lymphoma that characteristically contains malignant lymphocytes within blood vessels. The clinical presentation of IVLBCL has high variability. In our case, the patient’s initial presentation involved bilateral ptosis, restricted extraocular movements, periorbital pain, and bitemporal headache. The patient denied the classic “B symptoms” such as fever, night sweats, or weight loss. The patient also denied a family history of malignancy. Initial imaging studies were unremarkable, making diagnosis particularly challenging. Ultimately, functional endoscopic sinus surgery was performed. Pathological examination of the intraoperative specimen revealed a CD5+ large B-cell lymphoma within the vessels involving the left ethmoid sinus, respiratory mucosa, and nasal septum. The patient underwent steroid therapy prior to diagnosis, which led to rapid improvement in headache and mild improvement in extraocular function and ptosis. Following diagnosis, the patient underwent chemotherapy with supportive medications. Our case report may be considered a reference for cases presenting with extensive bilateral extraocular muscle deficits and levator palpebrae dysfunction in the absence of notable initial imaging findings, “B symptoms,” or positive family history. The teaching point from this case is to demonstrate the difficulty of diagnosis and our train of thought in investigating an abnormal presentation with no clearly identifiable etiology following initial diagnostic workup and treatment.
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3
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A case of lung intravascular large B cell lymphoma developed with respiratory failure rescued by corticosteroid prior to definite diagnosis. Respir Med Case Rep 2022; 37:101625. [PMID: 35309974 PMCID: PMC8927840 DOI: 10.1016/j.rmcr.2022.101625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/02/2022] [Accepted: 03/07/2022] [Indexed: 11/20/2022] Open
Abstract
A 56-year-old man complained progressive dyspnea, fatigue and fever for one month. His chest CT exhibited faint ground-glass opacities, and the levels of serum LDH and soluble interleukin 2 receptor were markedly elevated. Positron emission tomography (PET) showed high uptake of 18-fluoro deoxy glucose (18FDG) only on both lungs. We performed transbronchial lung biopsies (TBLB) for the diagnosis. After bronchoscopy, he had prolonged hypoxemia. Because defects of 99m-Technetium macroaggregated albumin (99mTc-MAA) in pulmonary blood flow scintigraphy were consistent with the distribution of 18FDG uptake in PET, we speculated that the presence of intravascular lymphoma (IVL) cells in the capillaries might have behaved like tumor embolism. We started rescue by prednisolone based on treatment of lymphoma. As a result, his hypoxemia was gradually improved. Histological findings in TBLB specimen showed that CD20+CD79+Bcl-2+c-myc+ lymphoma cells were localized to small vessel lumina in alveoli and bronchioles, and he was definitely diagnosed with lung intravascular large B cell lymphoma (IVLBCL). He was treated with complete cyclophosphamide, doxorubicin, vincristine, and prednisolone with rituximab (R–CHOP) in combination with intrathecal methotrexate injection. After eight cycles of R–CHOP and three times of intrathecal methotrexate, 18FDG uptake of PET on both lungs completely disappeared, achieving complete metabolic remission. We experienced a rare case of lung IVLBCL developed with respiratory failure successfully rescued by prednisolone prior to definite diagnosis.
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Matsue K, Abe Y, Narita K, Kobayashi H, Kitadate A, Miura D, Takeuchi M, Takeuchi K. Bone marrow infiltration pattern in patients with intravascular large B-cell lymphoma diagnosed by random skin biopsy. EJHAEM 2020; 1:281-285. [PMID: 35847692 PMCID: PMC9175664 DOI: 10.1002/jha2.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/14/2022]
Abstract
We retrospectively analyzed bone marrow (BM) infiltration pattern in consecutive 30 intravascular large B-cell lymphoma (IVLBCL) patients diagnosed by random skin biopsy (RSB). BM infiltration of lymphoma was observed in 18 patients (60.0%), including five patients with the intrasinusoidal pattern with minimal extravasation, eight patients with the mixed of intrasinusoidal and scattered/interstitial or nodular infiltration, and five patients with the nodular/diffuse pattern. Twelve patients were negative for lymphoma infiltration. BM histology of patients with IVLBCL were diverse and frequently discordant with those of other site of IVLBCL lesions. BM biopsy had a poorer diagnostic performance for detecting intravascular features.
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Affiliation(s)
- Kosei Matsue
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Yoshiaki Abe
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Kentaro Narita
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Hiroki Kobayashi
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Akihiro Kitadate
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Daisuke Miura
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Masami Takeuchi
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Kengo Takeuchi
- Division of PathologyThe Cancer InstituteJapanese Foundation for Cancer ResearchTokyoJapan
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5
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Iwami E, Ito F, Sasahara K, Kuroda A, Matsuzaki T, Nakajima T, Abe D, Matsumoto K, Sasaki A, Eguchi K, Terashima T. Pulmonary Intravascular Large B-cell Lymphoma in a Patient Administered Methotrexate for Rheumatoid Arthritis. Intern Med 2020; 59:429-433. [PMID: 31619597 PMCID: PMC7028407 DOI: 10.2169/internalmedicine.3216-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A 70-year-old woman with rheumatoid arthritis undergoing methotrexate (MTX) treatment presented with dyspnea and a subfever. Computed tomography (CT) revealed a diffuse minimal ground-glass appearance in both lungs and splenomegaly. The gallium scintigram showed a diffuse, mild uptake in both lungs and the spleen. The lung biopsy specimen revealed the presence of CD20-positive atypical lymphocytes in the small pulmonary vessels. The patient was diagnosed with pulmonary intravascular diffuse large B-cell lymphoma (IVLBCL) and exhibited spontaneous regression after MTX was discontinued. This report describes a rare case of MTX-associated lymphoproliferative disorder expressing pulmonary IVLBCL.
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Affiliation(s)
- Eri Iwami
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Fumimaro Ito
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Kotaro Sasahara
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Aoi Kuroda
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Tatsu Matsuzaki
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Takahiro Nakajima
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Daichi Abe
- Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Kimihiro Matsumoto
- Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Aya Sasaki
- Department of Pathology and Laboratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Keisuke Eguchi
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Takeshi Terashima
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
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Tokushima M, Katsuki NE, Tago M, Yamashita SI. Intravascular Large B-Cell Lymphoma Presenting with Hypoxemia without any Abnormalities on Standard Imaging Studies. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1199-1204. [PMID: 31409762 PMCID: PMC6705343 DOI: 10.12659/ajcr.916877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patient: Female, 75 Final Diagnosis: Intravascular lerge B-cell lymphoma Symptoms: Dyspnea Medication: — Clinical Procedure: — Specialty: Hematology
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Affiliation(s)
- Midori Tokushima
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
| | - Shu-Ichi Yamashita
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
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CD5-Positive Intravascular Large B-Cell Lymphoma in a Patient with Wilson's Disease: Case Report and Review of the Literature. Case Rep Pathol 2019; 2018:5140586. [PMID: 30643658 PMCID: PMC6311313 DOI: 10.1155/2018/5140586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/24/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare extra-nodal B-cell lymphoma that proliferates within small/intermediate blood vessels and capillaries while sparing large blood vessels and organ parenchyma. Clinical presentation is highly variable and may include B symptoms, neurological deficits, and/or cutaneous findings. The diagnosis of IVLBCL is difficult due to multiorgan involvement and nonspecific symptoms. We describe the case of a 68-year-old male who presented with progressive weakness, confusion, and falls. He had a past medical history of liver cirrhosis secondary to Wilson's disease. Physical exam and laboratory results revealed a lethargic man with jaundice, hepatic encephalopathy, and abnormal liver/kidney function tests. He expired after a short hospital course in the setting of hepatic and renal failure. Postmortem examination revealed large neoplastic lymphoid cells involving multiple organ blood vessels; however skin and neurologic involvement was absent. The neoplastic cells demonstrated B-cells positive for CD5, rendering a diagnosis of IVLBCL. Our case represents the occurrence of IVLBCL with CD5-positivity in a patient with Wilson's disease, diagnosed at autopsy demonstrating the challenging nature of diagnosing IVLBCL.
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8
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Spencer J, Dusing R, Yap W, Hill J, Walter C. Intravascular large B-cell lymphoma presenting with diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding CT abnormality. Radiol Case Rep 2018; 14:260-264. [PMID: 30510608 PMCID: PMC6260434 DOI: 10.1016/j.radcr.2018.10.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 12/14/2022] Open
Abstract
A 60-year-old male presented with complaints of dyspnea, intermittent fever, and 40 pounds of weight loss over the previous 9 months and was admitted for acute hypoxemic respiratory failure. Labs demonstrated elevated inflammatory markers, mild anemia, and thrombocytopenia. Fluorodeoxyglucose-positron emission tomography scan demonstrated diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding abnormality on CT images. Excisional lung biopsy demonstrated intravascular large B-cell lymphoma (IV-LBCL). Presentation, imaging findings, and diagnosis of IV-LBCL will be discussed, as well as differential considerations for pulmonary involvement by IV-LBCL.
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Affiliation(s)
- Jayden Spencer
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
| | - Reginald Dusing
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
| | - Wendell Yap
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
| | - Jacqueline Hill
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
| | - Carissa Walter
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
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9
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Abe Y, Narita K, Kobayashi H, Kitadate A, Takeuchi M, Kikuchi Y, Ouchi T, Takeuchi K, Matsue K. Clinical value of abnormal findings on brain magnetic resonance imaging in patients with intravascular large B-cell lymphoma. Ann Hematol 2018; 97:2345-2352. [DOI: 10.1007/s00277-018-3481-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/19/2018] [Indexed: 12/18/2022]
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10
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Banjongjit A, Chiratikarnwong K, Saelue P, Sangmala S, Auepemkiate S, Kayasut K. Random skin biopsy for diagnosis of intravascular large B-cell lymphoma in a patient with hypoxemia and normal lung imaging. JAAD Case Rep 2018; 4:149-151. [PMID: 29387769 PMCID: PMC5789758 DOI: 10.1016/j.jdcr.2017.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Athiphat Banjongjit
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Kanokphorn Chiratikarnwong
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Pirun Saelue
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Siripan Sangmala
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sauvarat Auepemkiate
- Department of Pathology, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Kanita Kayasut
- Department of Pathology, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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11
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Intravascular large B-cell lymphoma as a cause of terminal acute respiratory distress syndrome: atypical presentation of a rare disease. Aging Clin Exp Res 2018; 30:97-99. [PMID: 28444517 DOI: 10.1007/s40520-017-0754-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/30/2017] [Indexed: 12/14/2022]
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12
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Sitthinamsuwan P, Chinthammitr Y, Pattanaprichakul P, Sukpanichnant S. Random skin biopsy in the diagnosis of intravascular lymphoma. J Cutan Pathol 2017. [PMID: 28626893 DOI: 10.1111/cup.12984] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Random skin biopsy (RSB) is a method for diagnosis of intravascular lymphoma (IVL). However, the indications for RSB to diagnose IVL have not yet been established. The aim of this study was to determine the appropriate indications for RSB to diagnose IVL. METHODS Thirty-two patients with fever of unknown origin (FUO) and without skin lesion underwent RSB for diagnosis of IVL. Clinical data, including fever, neurological symptoms, hematologic disorders, organomegaly, bone marrow (BM) study, hypoxemia and serum level of lactate dehydrogenase (LDH), were evaluated. RESULTS Seven of 32 patients were definitively diagnosed with IVL. In addition to FUO, 2 IVL patients also suffered from dyspnea and neurological disorders. Patients who had FUO with accompanying hematologic disorders, high LDH, negative BM study and no lymphadenopathy or hepatosplenomegaly had a significant tendency to have IVL by RSB (P = .03). FUO with hypoxemia was also identified as a significant indication for RSB (P = .02). CONCLUSIONS RSB is a reliable method for diagnosis of IVL, especially in patients with FUO and any 1 or more of the 4 following abnormalities: (1) hematologic abnormalities; (2) high serum LDH; (3) hypoxemia; and/or, (4) unusual neurological symptoms with co-existing hematologic abnormalities and without lymphadenopathy, hepatosplenomegaly or BM abnormality.
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Affiliation(s)
- Panitta Sitthinamsuwan
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yingyong Chinthammitr
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Penvadee Pattanaprichakul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sanya Sukpanichnant
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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13
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The Value of 18F-FDG PET/CT in Diagnostic Procedure of Intravascular Large B-Cell Lymphoma Presenting Fever of Unknown Origin and Pulmonary Hypertension as an Initial Manifestation. Clin Nucl Med 2017; 41:506-7. [PMID: 26914573 DOI: 10.1097/rlu.0000000000001188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A 57-year-old man presented with fever of unknown origin and pulmonary hypertension. An F-FDG PET/CT scan was performed to evaluate the source of fever, which showed diffuse, homogeneously increased FDG uptake in both lungs, which prompted the transbronchial lung biopsy. The pathological examination from biopsy specimen demonstrated intravascular large B-cell lymphoma.
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14
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Takeshige T, Harada N, Sekimoto Y, Kanemaru R, Tsutsumi T, Matsuno K, Shiota S, Masuda A, Gotoh A, Asahina M, Uekusa T, Takahashi K. Pulmonary Intravascular Large B-cell Lymphoma (IVLBCL) Disguised as an Asthma Exacerbation in a Patient with Asthma. Intern Med 2017; 56:1885-1891. [PMID: 28717087 PMCID: PMC5548684 DOI: 10.2169/internalmedicine.56.7613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 62-year-old man with asthma presented with a 1-month history of wheezing and exertional dyspnea. Although the wheezing symptoms disappeared after systemic corticosteroid therapy, the exertional dyspnea and hypoxemia did not improve. A diagnosis of intravascular large B-cell lymphoma (IVLBCL) with pulmonary involvement was suspected because of the increased serum lactic dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R) level, increased alveolar-arterial oxygen difference (AaDO2), decreased pulmonary diffusing capacity for carbon monoxide (DLCO) and scintigraphic, computed tomography (CT) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT findings. The patient was diagnosed as having IVLBCL with pulmonary involvement based on a pathological analysis of a random skin biopsy and a transbronchial lung biopsy. IVLBCL should be considered in patients with symptoms of asthma that are refractory to corticosteroid treatment.
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Affiliation(s)
- Tomohito Takeshige
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Yasuhito Sekimoto
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Ryota Kanemaru
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Takeo Tsutsumi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Kei Matsuno
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Satomi Shiota
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Azuchi Masuda
- Department of Hematology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Akihiko Gotoh
- Department of Hematology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Miki Asahina
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Toshimasa Uekusa
- Department of Pathology, Labour Health and Welfare Organization Kanto Rosai Hospital, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
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15
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Moon JY, Park WH, Kim JM, Choi YS, Song IC, Lee HJ, Jo DY, Kim S, Yang YJ, Kim SS, Kim JH, Yun HJ. Two Cases of Intravascular Lymphoma Presenting with Pulmonary Involvement. J Korean Med Sci 2016; 31:1011. [PMCID: PMC4900989 DOI: 10.3346/jkms.2016.31.7.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 04/07/2016] [Indexed: 09/22/2023] Open
Affiliation(s)
- Ji Young Moon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Won Hong Park
- Department of Radiology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jin Man Kim
- Department of Pathology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yoon Seok Choi
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ik-Chan Song
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyo Jin Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Deog-Yeon Jo
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Samyong Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Young Jun Yang
- Department of Internal Medicine, Daejeon St. Mary's Hospital, Catholic University of Korea University College of Medicine, Daejeon, Korea
| | - Song Soo Kim
- Department of Radiology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jin Hwan Kim
- Department of Radiology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hwan-Jung Yun
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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Abstract
Intravascular large B cell lymphoma (IVLBCL) is a rare type of extranodal diffused large B-cell lymphoma. IVLBCL with primary lung lesion is very rare and it is very difficult to diagnose. Radiographic findings of pulmonary IVLBCL are nonspecific and resembling interstitial lung diseases. Reversed halo sign (RHS) was initially reported in patients diagnosed with cryptogenic organizing pneumonia and then described in a variety of diseases with inflammatory, infectious, autoimmune, and malignant causes. This is the first case of IVLBCL that has presented with RHSs on CT scan.A 59-year-old Chinese man presented with a 4-month history of a nonproductive cough and a weight loss of 5 kg. Physical examination was unremarkable. High-resolution computed tomography scan of the chest showed bilateral patchy ground glass opacities (GGOs) and RHSs. Laboratory tests were unremarkable except elevated serum lactate dehydrogenase (LDH). Surgical lung biopsy was performed. Light microscopic examination of the specimen disclosed diffuse alveolar septal widening caused by neoplastic lymphocytes, which were positive for CD20 and infiltrated in the alveolar capillaries. The patient was diagnosed with IVLBCL and underwent chemotherapy and autologous blood stem cell transplantation. The patient is still alive 5 years after diagnosis.IVLBCL is a rare cause of RHS and should be considered in differential diagnosis of RHS. An increased serum LDH concentration is another important clue.
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Affiliation(s)
- Min Peng
- From the Department of Respiratory Medicine (MP, JS); Department of Pathology (HL), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Medicine, Division of Integrative Medicine, Mayo Clinic, Rochester, MN (GL)
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17
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Colavolpe C, Ebbo M, Trousse D, Khibri H, Franques J, Chetaille B, Coso D, Ouvrier MJ, Gastaud L, Guedj E, Schleinitz N. FDG-PET/CT is a pivotal imaging modality to diagnose rare intravascular large B-cell lymphoma: case report and review of literature. Hematol Oncol 2014; 33:99-109. [PMID: 24850057 DOI: 10.1002/hon.2140] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/13/2014] [Accepted: 03/05/2014] [Indexed: 12/14/2022]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) remains a diagnostic challenge, because of non-specific findings on clinical, laboratory, and imaging studies. We present a case in which 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography was particularly useful to suspect the diagnosis, to detect unexpected locations, to guide contributive biopsy, and to assess the response to treatment. In case of initial negative results, FDG-PET should be repeated in the course of clinical evolution. In the presence of neurological or hormonal symptoms without brain magnetic resonance imaging abnormality, FDG-PET brain slices could depict additional pituitary and/or brain hypermetabolisms. We discuss the potential interests of FDG-PET in IVLBCL by a literature review.
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Affiliation(s)
| | - Mikael Ebbo
- Department of Internal Medicine, CHU Conception, Marseille, France
| | | | - Hajar Khibri
- Department of Internal Medicine, CHU Conception, Marseille, France
| | | | - Bruno Chetaille
- Department of Bio-pathology, Institut Paoli-Calmettes, Marseille, France
| | - Diane Coso
- Department of Onco-hematology, Institut Paoli-Calmettes, Marseille, France
| | | | - Lauris Gastaud
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Eric Guedj
- Department of Nuclear Medicine, CHU Timone, Marseille, France
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Huprikar NA, Kurtz MT, Mount CA. Massive splenomegaly and lymphopenia: a unique case of obstructive shock. BMJ Case Rep 2013; 2013:bcr-2013-201643. [PMID: 24172780 DOI: 10.1136/bcr-2013-201643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We present a patient with intravascular large B-cell lymphoma (IVLBCL)-induced obstructive shock. This case represents a unique presentation of the disease, while highlighting the difficulty of establishing the diagnosis. Although there was a high clinical suspicion for a lymphomatous process, the obstructive shock component of the patient's presentation was perplexing. It was not until the autopsy reports demonstrated lymphocytes within the pulmonary vasculature that the clinical picture of altered mental status, weight loss and obstructive shock were unified to the diagnosis of intravascular large B-cell lymphoma.
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Affiliation(s)
- Nikhil Anand Huprikar
- Department of Internal Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
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Murakami J, Shimizu Y. Hepatic manifestations in hematological disorders. Int J Hepatol 2013; 2013:484903. [PMID: 23606974 PMCID: PMC3626309 DOI: 10.1155/2013/484903] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/11/2013] [Accepted: 02/11/2013] [Indexed: 12/17/2022] Open
Abstract
Liver involvement is often observed in several hematological disorders, resulting in abnormal liver function tests, abnormalities in liver imaging studies, or clinical symptoms presenting with hepatic manifestations. In hemolytic anemia, jaundice and hepatosplenomegaly are often seen mimicking liver diseases. In hematologic malignancies, malignant cells often infiltrate the liver and may demonstrate abnormal liver function test results accompanied by hepatosplenomegaly or formation of multiple nodules in the liver and/or spleen. These cases may further evolve into fulminant hepatic failure.
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Affiliation(s)
- Jun Murakami
- The Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Yukihiro Shimizu
- Gastroenterology Unit, Takaoka City Hospital, Toyama 933-8550, Japan
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Yamashita H, Suzuki A, Takahashi Y, Kubota K, Kano T, Mimori A. Intravascular large B-cell lymphoma with diffuse FDG uptake in the lung by 18FDG-PET/CT without chest CT findings. Ann Nucl Med 2012; 26:515-21. [PMID: 22539250 PMCID: PMC7102326 DOI: 10.1007/s12149-012-0600-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/03/2012] [Indexed: 12/14/2022]
Abstract
We report a rare case of intravascular large B-cell lymphoma (IVLBCL) with diffuse fluorodeoxyglucose (FDG) uptake in the lung by 18FDG-positron emission tomography/computed tomography (PET/CT). CT showed nodular shadow, whereas diffuse FDG uptake in PET/CT suggested IVLBCL in the lung. A random skin biopsy provided histological evidence of IVLBCL. The patient responded well to combination chemotherapy. Only two cases of IVLBCL in which diffuse pulmonary FDG uptake was demonstrated have been reported previously. FDG-PET/CT plus random skin biopsy may be useful for the early diagnosis of IVLBCL with pulmonary involvement even without convincing radiological findings in the lung.
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Affiliation(s)
- Hiroyuki Yamashita
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan.
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Jitpratoom P, Yuckpan P, Sitthinamsuwan P, Chotinaiwattarakul W, Chinthammitr Y. Progressive multifocal cerebral infarction from intravascular large B cell lymphoma presenting in a man: a case report. J Med Case Rep 2011; 5:24. [PMID: 21251318 PMCID: PMC3036638 DOI: 10.1186/1752-1947-5-24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 01/20/2011] [Indexed: 12/23/2022] Open
Abstract
Introduction Intravascular lymphoma is rare, and may present as ischemic stroke. Diagnosis is difficult due to the non-specific presentation and lack of lymphadenopathy, thus leading to frequent instances of autopsy-proven diagnosis. To the best of our knowledge, this is the first report of progressive stroke from intravascular lymphoma diagnosed antemortem by random skin biopsy. Case presentation A 42-year-old Thai man presented to our hospital with progressive multifocal cerebral infarction. Despite taking aspirin (300 mg/day), his neurological symptoms worsened. During admission, he developed an unexplained fever and hypoxemia. Magnetic resonance angiography clearly showed patency of all cerebral arteries including the internal carotid and vertebrobasilar arteries. Echocardiography, an antiphospholipid antibody test, cerebrospinal fluid cytology and a bone marrow study were normal. Other laboratory test results showed an elevated lactate dehydrogenase level, nephrotic range proteinuria (3.91 g/day), hypoalbuminemia (1.9 g/dL), a very low high-density lipoprotein level (7 mg/dL) and hypertriglyceridemia (353 mg/dL). Because of suspected vasculitis, pulse methylprednisolone was given with transiently minimal improvement. A random skin biopsy from both thighs revealed intravascular large B cell lymphoma. Chemotherapy was not given due to our patient having ventilator associated pneumonia. He died 10 days after the definite diagnosis was established. Conclusion One etiology of stroke is intravascular lymphoma, in which random skin biopsy can be helpful for antemortem diagnosis.
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Affiliation(s)
- Pornpong Jitpratoom
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Kotake T, Kosugi S, Takimoto T, Nakata S, Shiga J, Nagate Y, Nakagawa T, Take H, Katagiri S. Intravascular large B-cell lymphoma presenting pulmonary arterial hypertension as an initial manifestation. Intern Med 2010; 49:51-4. [PMID: 20046001 DOI: 10.2169/internalmedicine.49.2774] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a 39-year-old man with intravascular large B-cell lymphoma (IVLBCL) who had been treated as a case with pulmonary arterial hypertension (PAH) for one year. After he became worse, diffuse pulmonary (18)F-fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) suggested the existence of IVLBCL in the lung showing normal CT images. The diagnosis was confirmed with random transbronchial lung biopsy, and he was then successfully treated. Since IVLBCL presenting PAH has been rare and is difficult to diagnose, early application of FDG-PET may provide early recognition of the disorder, leading to a better outcome.
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Affiliation(s)
- Takeshi Kotake
- Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Japan.
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Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare disease entity of non-Hodgkin lymphoma according to the current WHO classification. This rare form of B-cell lymphoma is characterised by selective growth of tumour cells in the lumina of small vessels of various organs. Strange characteristics of IVLBCL, including the absence of marked lymphoadenopathy and the usually aggressive clinical behaviour, result in the delay of timely and accurate diagnosis and fatal complications. Thus, the prognosis of IVLBCL is extremely poor. The success achieved with the anti-CD20 chimeric monoclonal antibody, rituximab, represents an important milestone in the clinical practice of B-cell lymphoma. An advantage of adding rituximab to conventional chemotherapies has been shown, in the process of increasing our understanding of the clinical and pathological manifestations for IVLBCL. This Review describes the cutting edge of research on IVLBCL, and discusses the unsolved issues from biological and clinical perspectives to provide a better understanding of this rare lymphoma.
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Kitanaka A, Kubota Y, Imataki O, Ohnishi H, Fukumoto T, Kurokohchi K, Tanaka T. Intravascular large B-cell lymphoma with FDG accumulation in the lung lacking CT/67gallium scintigraphy abnormality. Hematol Oncol 2009; 27:46-9. [DOI: 10.1002/hon.876] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Felizardo M, Mendes A, Fernandes A, Campos P, Magalhães V, Correia I, Pignatelli A, Ferreira C, Sotto-Mayor R, de Almeida AB. Linfoma intravascular do pulmão: A propósito de um caso clínico com boa resposta à terapêutica. REVISTA PORTUGUESA DE PNEUMOLOGIA 2008. [DOI: 10.1016/s0873-2159(15)30291-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Shimada K, Matsue K, Yamamoto K, Murase T, Ichikawa N, Okamoto M, Niitsu N, Kosugi H, Tsukamoto N, Miwa H, Asaoku H, Kikuchi A, Matsumoto M, Saburi Y, Masaki Y, Yamaguchi M, Nakamura S, Naoe T, Kinoshita T. Retrospective Analysis of Intravascular Large B-Cell Lymphoma Treated With Rituximab-Containing Chemotherapy As Reported by the IVL Study Group in Japan. J Clin Oncol 2008; 26:3189-95. [DOI: 10.1200/jco.2007.15.4278] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose To evaluate the safety and efficacy of rituximab-containing chemotherapies for intravascular large B-cell lymphoma (IVLBCL). Patients and Methods We retrospectively analyzed 106 patients (59 men, 47 women) with IVLBCL who received chemotherapy either with rituximab (R-chemotherapy, n = 49) or without rituximab (chemotherapy, n = 57) between 1994 and 2007 in Japan. The median patient age was 67 years (range, 34 to 84 years). The International Prognostic Index was high-intermediate/high in 97% of patients. Results The complete response rate was higher for patients in the R-chemotherapy group (82%) than for those in the chemotherapy group (51%; P = .001). The median duration of follow-up for surviving patients was 18 months (range, 1 to 95 months). Progression-free survival (PFS) and overall survival (OS) rates at 2 years after diagnosis were significantly higher for patients in the R-chemotherapy group (PFS, 56%; OS, 66%) than for patients in the chemotherapy group (PFS, 27% with P = .001; OS, 46% with P = 0.01). Multivariate analysis revealed that the use of rituximab was favorably associated with PFS (hazard ratio [HR], 0.45; 95% CI, 0.25 to 0.80; P = .006) and OS (HR, 0.42; 95% CI, 0.21 to 0.85; P = .016). Treatment-related death was observed in three patients (6%) who received R-chemotherapy and in five patients (9%) who received chemotherapy. Conclusion Our data suggest improved clinical outcomes for patients with IVLBCL in the rituximab era. Future prospective studies of rituximab-containing chemotherapies are warranted.
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Affiliation(s)
- Kazuyuki Shimada
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Kosei Matsue
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Kazuhito Yamamoto
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Takuhei Murase
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Naoaki Ichikawa
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Masataka Okamoto
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Nozomi Niitsu
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Hiroshi Kosugi
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Norifumi Tsukamoto
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Hiroshi Miwa
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Hideki Asaoku
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Ako Kikuchi
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Morio Matsumoto
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Yoshio Saburi
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Yasufumi Masaki
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Motoko Yamaguchi
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Shigeo Nakamura
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Tomoki Naoe
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
| | - Tomohiro Kinoshita
- From the Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital; Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya; Division of Hematology/Oncology, Kameda General Hospital, Kamogawa; Department of Internal Medicine, Nishio Municipal Hospital, Nishio; First Department of Internal Medicine, Nagano Red Cross Hospital, Nagano; Department of Medicine, Fujita-Health
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